A cross‐sectional study of the impact of COVID‐19 pandemic on the physical activity of Jordanian population

Abstract Background Since the declaration of the COVID‐19 pandemic on 11th March 2020, the public health recommendations have applied lockdowns and restrictions to limit the spread of the disease. These measures determined outdoor activities and access to many forms of exercise. Objective The primary objective of this study was to examine the impact of the COVID‐19 pandemic on the physical activity (PA) of the Jordanian population. Methods A cross‐sectional online survey was designed using Google Forms services and distributed on social media platforms during the first two weeks of November 2020 to evaluate the exercise activity changes during the COVID‐19 pandemic in the study population. In this research, we included those who perform any form of physical activity (n = 1103). The data collected were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26 (IBM SPSS Corp, SPSS Statistics ver. 26, USA). The categorical variables were summarized as frequencies and proportions and were compared using the Chi‐square. For all analyses, P‐value less than 0.05 was considered statistically significant. Results A total of 1103 out of 2,511 (43.9%) respondents who participated in the survey were physically exercising during the COVID‐19 pandemic. 41.8% were exercising at an irregular frequency, while 21.5% were exercising daily, 16.8% were exercising three to five times a week, and 19.9% were exercising once or twice a week. Moreover, 282 (25.6%) respondents started doing some form of exercise during the pandemic. Those significantly were less than 18‐year‐old, male gender, were single, were non‐smokers, and had a diploma or bachelor's degree in a health‐related major. These changes in the level of exercise have been attributed by 57.8% of respondents to the health aspects where they realized the importance of exercising in strengthening the immune system against diseases, including COVID‐19. Conclusion The current study showed that lockdown, due to the COVID‐19 pandemic, had a positive impact on the healthy lifestyle of the Jordanian population which was attributed to their feeling of the importance of sports practice on the immune system and the availability of time for those activities. However, the younger and individuals were more aware of the importance of these practices which highlights the importance of considering other age groups in future studies of healthy behaviors.

detrimental to the population's health in the long run 6 as physical exercise is believed to be one of the most powerful lifestyle measures to cope with stressful events 7,8 such as the COVID-19 pandemic.
In the majority of emerging studies, the restrictions have resulted in lower overall PA 9-12 and access to exercise despite the increased availability of PA classes and guidance on social media during the pandemic. 13 On the other hand, some other people take advantage of their time during the quarantine and increase their level of exercise. 6,14,15 The effect of the COVID-19 pandemic on PA and other healthy lifestyle measures is still under review. Nonetheless, this effect needs to be taken into consideration when applying isolation regulations to people and the benefits must be weighed against the risks to provide a health policy that is in people's best interest. 11 Given all of the above, the COVID-19 pandemic is having a significant impact on multiple lifestyle interventions including people's PA, whether these effects are positive or negative. The main aim of this study is to examine and discuss how these parameters changed during the quarantine among a Jordanian sample.   Table 1. The majority of them were females (73.8%) and 66.0% of them were in the age group between 18 and 35 years old. However, 72 (6.5%) were children under the age of 18 years. The response rate was higher among those who live in a city; accounting for around 76.0% of the total responses. Seven hundred and six (64.0%) of them were single and 568 (51.5%) lived in a family of four to six members.
Pointing to the respondent's level of education, 806 (73.1%) of them had a diploma or bachelor's degree including 357 (32.4%) who have a degree in a health-related major while 68.9% of them were unemployed. Nine hundred eighty-nine (89.7%) do not suffer from any chronic illnesses and 879 (81.3%) were nonsmokers.

| PA
Nearly 1103 (43.9%) respondents were doing a minimum of one form of physical exercise during the COVID-19 pandemic; 237 (21.5%) of them were exercising almost everyday, 185 (16.8%) were exercising three to five times a week, and 461 (41.8%) were exercising in an irregular frequency (Figure 1). In addition, individuals who were performing PA (n = 1103) showed that 316 (28.6%) have realized the importance of exercise but did not accordingly include it in their daily routine, so they exercised less since the beginning of the pandemic.
While 282 (25.6%) have started doing some form of exercise, and 219 (19.9%) have regularly exercised before the pandemic and they have been more driven to exercise since the pandemic started ( Figure 2). (Tables 2-4).
The significant associations with those who were performing PA are as follows: the male gender (p < 0.001), weight loss during the pandemic (p < 0.001), decrease or no change in the number of meals during the day (p = 0.001), no change in the number of meals during the night (p = 0.001), decrease in appetite (p = 0.02), downloading any applications or starting to follow any social media accounts concerning healthy lifestyle, nutrition, PA, and exercise (p < 0.001).
On the other hand, no significant statistical association was observed with each of these parameters: age, social status, number of household members, educational level, occupation, chronic illness, using electronic devices, and smoking status (p < 0.05) ( Table 2).

| Frequency of PA
The male individuals showed that 103 individuals (35.6%) were exercising irregularly, 73 individuals (25.3%) were exercising three to five times a week, and 66 individuals (22.8%) were exercising almost everyday. On the contrary, the female results showed that 358 (44.0%), 112 (13.8%), and 171 (21.0%) were exercising irregularly, three to five times a week, almost everyday, respectively. This concludes that males were exercising regularly from three to five times a week more than females by 1.8-fold.
Also, females were performing exercises at an irregular frequency more than males by 1.2-fold (Table 3).
Almost everyday PA was noticed among 46.1% of individuals who has been exercising more during the pandemic than before, 21.3% who has no change in their level of exercise during the pandemic, 17.7% who started doing some exercise during the pandemic, and 7.9% who did not start to exercise although they have realized the importance of doing so. This means that those who exercised more during the pandemic than before had regularly exercised everyday more by 5.8-fold than those who did not start exercise (p < 0.001).

| Changing the level of exercise
As shown in Figure 3, nearly 25.6% of the participants stated that they have started doing some form of exercise during the pandemic. weight or appetite, no change in the using of electronic devices during the pandemic, being a smoker, starting to follow social media accounts concerning healthy nutrition and PA (p value for all >0.05) ( Table 4). In addition, around 57.8% of the respondents said that the main concern about performing PA was due to the health aspects where they realized the importance of exercising in strengthening the immune system against diseases, including COVID-19. Likewise, 54.5% of the respondents stated that the extra free time due to the lockdown and studying or working from home had significant effects.
Only 20.4% of them found that the influence of family members, Do you currently perform any form of physical exercise (this includes walking, jogging, or any activity requiring physical exertion)?  Have you noticed any change in your level of exercise or even a change in the way you think of exercise since the beginning of the pandemic?

T A B L E 4 (Continued)
Have you noticed any change in your level of exercise or even a change in the way you think of exercise since the beginning of the pandemic?

T A B L E 4 (Continued)
Have you noticed any change in your level of exercise or even a change in the way you think of exercise since the beginning of the pandemic? friends, physicians, or social media affected their level of exercise during the pandemic (Figure 3).

| DISCUSSION
On March 17, 2020, in an attempt to control and limit the spread of  On the other hand, there was no statistical association between respondents who perform PA and social status, the number of household members, educational level, occupation, chronic illness, using electronic devices, smoking status, and age. However, according to Qin in a study with a sample size of (n = 12107), Chinese adults aged between 18 and 80, the group with the highest prevalence of insufficient PA was found among young adults aged 20-34 years. 20 In contrast, a lower prevalence of insufficient PA was found in those aged 55-59 years (41.1%) and over 60 years old (41.3%) during the COVID-19 lockdown. 20 There was also a strong association found between the increased number of household members and the frequency of exercise. 81.7% of participants come from households with four or more members, 34% of which exercise in an irregular pattern while 7.8% of participants who are members of households that contain three or fewer members exercised in that same manner. Comparably, the percentage of household members of four or more who exercise almost everyday is 18.6% which exceeds 2.9% representing individuals of household members of three or less in that same category.
In the current study, 31.9% of participants who live in cities were engaging in PA in an irregular manner, compared to 9.6% and 0.3% of participants who live in villages or refugee camps, respectively. It was also found that people living in cities who exercise almost everyday were 15.0% in comparison to 5.9% of participants who live in villages and 0.5% who live in refugee camps. Similar percentages were also found regarding exercising once or twice a week and three to five times a week.
In an attempt to understand the general trends affecting PA during the COVID-19 pandemic, an online survey was conducted by Lesser in Canada and concluded that 40.5% of inactive individuals were more likely to become less active during the pandemic while a smaller percentage of already active individuals 22.4% showed increased PA. 24 When assessing the same concept amongst our Jordanian sample, participants were asked about noticing any change in their level of exercise or even a change in the way they perceive exercise since the beginning of the pandemic was found as follow, 25.9% of participants reported no change, and 13.1% of them reported exercising irregularly. 28.6% of people reported realizing the importance of exercise without necessarily applying it to their daily routine. While 9.2% of people who exercised before the pandemic but were more driven to exercise since it began reported they exercised almost daily compared to 2.0% of participants in the same category who reported irregular exercise.
To understand the association between the COVID-19 pandemic The current findings showed that respondents who are nonsmokers were more likely to start doing some sort of exercise during the pandemic compared to smokers (which includes regular smoking, electronic smoking, hookah, etc. Both gender and social status were also linked to the level of physical exercise. In particular, 21.8% of females reported realizing the importance of exercise without necessarily applying it to their routine followed by 20.5% of females who have started to do some form of exercise since the start of the pandemic. All while 7.3% of males reported no change in their level of exercise. As for the social status, we found that single people were more likely to exercise before and after the start of the pandemic.

| CONCLUSION
In conclusion, our study showed that COVID-19 and its lockdown had a significant impact on the population's lifestyles including PA.
Most of our sample, who were doing any form of physical exercise during the COVID-19 pandemic, experienced a change in their level of exercise either increased, decreased, or started doing PA since the beginning of the pandemic. These changes were mostly attributed to realizing the importance of exercising in strengthening the immune system against diseases, extra free time, and social factors. In general, the study showed that respondents who were doing any form of exercise during the pandemic were more likely to adopt a healthy lifestyle during the pandemic in comparison with nonperformingexercise respondents. Moreover, among performing-exercise respondents themselves, those who increased their activity during the pandemic were also more likely to adopt a healthy lifestyle during the pandemic.

| LIMITATIONS
As previously mentioned in the methodology section, a multisection online questionnaire was designed and distributed in November. We faced a potential limitation in recall bias since the Jordanian governmentenforced quarantine in March. There could also be potential reporting bias as the questionnaire was self-reported. In addition, another limitation could be a small ratio of male to female participants, which was 1:3.4.
Taking into consideration all the predicted limitations, we managed to subdue the aforementioned by collecting a sufficient and representative sample and using appropriate statistical tools.

ACKNOWLEDGMENT
This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

CONFLICT OF INTEREST
The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT
The supporting data of the findings of this study are available on request from the corresponding author.

TRANSPARENCY STATEMENT
The lead author Raed M. Al-Zoubi affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. Please choose the answer that suits you best. Extra free time due to lockdown and studying/working from home.
The health aspect (I realized the importance of exercising in strengthening the immune system against diseases including Covid-19).
The social aspect (the influence of family members, friends, physicians or social media).

Section 3 of 6: Eating habits
In this section, we want to know about your eating habits and diet and what changes you might have made in the current circumstances.
Please answer these questions regarding your eating habits (before the start of the pandemic).
Eating habits (before the start of the pandemic).
Q: Fast food intake: − Once a month or less.
− Once a week.
− Three to four times a week.
Q: Sugar intake (this includes sweets and desserts, sodas, sweetened juices, biscuits, chocolate, etc.): − Once a month or less.
− Once a week.
− Three to four times a week.
Q: Fat and oil intake (this includes any foods that contain vegetable oil or any hydrogenated or trans-fats): − Once a month or less.
− Once a week.
− Three to four times a week.

Q: Fresh fruit and vegetable intake:
− Once a month or less.
− Once a week.
− Three to four times a week.
Please answer these questions regarding your eating habits (after the start of the pandemic).
Eating habits (after the start of the pandemic).
Q: Fast food intake: − Once a month or less.
− Once a week.
− Three to four times a week.
− Almost daily. Q: Please select from the following statements what you think has affected your eating habits and diet during the pandemic: − The economic aspect (being off work or losing a job, limited availability of food products and produce, and the closing of restaurants and cafes).
− Extra free time due to lockdown and studying/working from home.
− The health aspect (realizing the importance of a healthy and balanced diet in strengthening the immune system against diseases including COVID-19).
− The social aspect (the influence of family members, friends, physicians or social media). Days off from work, losing a job, income limitations.
The general lockdown of cafés and public smoking lounges, and so forth.
Health factor (I realized the adverse effects smoking might have on the immune system that is vital to fight off diseases like . Social factor (influence of family members and friends).
Psychological factor (different stressors due to the financial burden of losing a job or online working or studying, etc…).
Free time and boredom due to the general lockdown and quarantine. Yes, I think nutritional supplements can boost immunity and protect against the disease.
I do not think nutritional supplements have any role in that.
I do not know.
*Thank you for participating in our questionnaire.
We wish you, your family and your loved one's health and well-being.